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Peer's doubts on sliding scale plan

A Labour lord has cast doubt over the effectiveness of a civil 'sliding scale' standard of proof in fitness to practise hearings, warning that a low standard of proof could cause miscarriages of justice.

Lord Turnberg's comments in the House of Lords' first debate on the regulation white paper add weight to Pulse's campaign against the change, which is a key feature of the document published in February.The proposal would mean different levels of proof would be needed to satisfy a panel that a doctor was guilty, depending on the severity of allegations.The civil standard currently requires that allegations are proven 'on the balance of probabilities', whereas the criminal standard uses the stricter 'beyond reasonable doubt' test.Lord Turnberg, who is president of the Medical Protection Society, said last week that he had 'very real concerns' and warned that a flexible approach left open the potential for 'considerable inconsistencies between similar cases in the judgment of the panels'.He said: 'Of course we must protect patients and remove dangerous doctors, but one wants to be pretty clear about the safety of judgments.'A low standard of proof leaves open the real risk of miscarriages of justice.'Lord Turnberg said that using a higher standard when required was so dependent on the training of judging panels and their ability to be consistent that it was difficult to see how it would work 'fairly and justly' for patients and doctors.He called for a rethink and possibly a pilot study to find ways of making the proposals work 'consistently and fairly'.

Fitness-to-practise milestones

• Under the reforms proposed in the regulation white paper, there will be scope to try doctors at different levels of proof according to the severity of the charge• The white paper pulled back from the original proposals to judge all cases on the civil standard outlined in Sir Liam Donaldson's Good Doctors, Safer Patients• Pulse's petition of 1,065 GPs was cited as evidence of strength of opposition from doctors

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